Clinical ophthalmology (Auckland, N.Z.)最新文献

Background: Intravitreal injections are among the most frequently performed eye procedures worldwide. They are vital in managing vision-related retinal conditions such as neovascular age-related macular degeneration, diabetic macular edema and retinal vein occlusion. This review scopes qualitative research concerning people's beliefs, perspectives, experiences and behaviors towards intravitreal injections.

Methods: Academic databases (PubMed, Embase, CINAHL and Web of Science) were searched for studies focused on qualitative research of intravitreal injections in adult patients, published between January 2000 and May 2024. We extracted data regarding publication and participants' characteristics, main study objectives, and methodological approaches.

Results: Of the 795 identified citations, 28 met the inclusion criteria. Most studies reported on patients' emotional experiences of undergoing intravitreal injections, with the fear of vision loss compounded with ongoing injections prompting significant anxiety and uncertainty for patients. Other studies also reported on the physical component as the invasiveness of the procedure caused pain and discomfort, which varied with the clinician's delivery of the injection. One study reported on clinician experiences of performing intravitreal injections, stating that the treatment decisions are dependent on patient-related factors such as their adherence to regular injections. Overall, qualitative research in ophthalmology is increasing, with most studies employing semi-structured interviews with thematic analysis.

Conclusion: Qualitative research offers valuable insights into both patient and clinician experiences of intravitreal injections, which can shape person-centered and sustainable models of intravitreal treatment. Understanding qualitative factors such as personal experiences and barriers to treatment can refine the delivery of intravitreal injections and ultimately improve patient adherence.

As intraocular lens (IOL) technology continues to evolve, the selection of an optimal refractive target has become increasingly complex and critical to achieving patient satisfaction following cataract surgery or refractive lens exchange. A recently proposed classification system divides IOLs into partial- and full-range-of-field categories based on defocus curve characteristics. However, this framework does not fully capture the diversity of modern IOL designs or account for key optical factors such as spherical aberration and lens-specific tolerance to residual refractive error. This review highlights the importance of understanding the interaction between IOL optical properties-particularly spherical aberration profiles-and refractive target strategies. It examines how different IOL designs, including enhanced monofocal, extended depth-of-field (EDOF), and full-range-of-vision lenses (eg, multifocal or spiral optics), respond to various refractive targets. The evidence suggests that a universal refractive target (eg, plano) may be suboptimal for many advanced IOLs and that customized refractive planning-often incorporating mini-monovision or asymmetrical targets-can improve visual outcomes. Future research should aim to standardize defocus measurement techniques and refine classification systems to better guide clinical decision-making.

Purpose: As the growing number of diabetic retinopathy (DR), the demands for screening requests and eye care services are expected to increase. While different screening models have been reported, there are several articles in literature of nurse-led DR screening. The purpose of this review was to define the roles and contributions of nurses in DR screening, identify the necessary supports required, and address the challenges that need to be resolved.

Methods: The literature search for the included articles was performed in the following databases: PubMed, CINAHL, Cochrane, Embase, and Web of Science. This search was conducted from the start of May 2025. Two reviewers independently screened all articles. If predefined inclusion criteria were met, the studies were further descriptive content, and data were summarized and individually evaluated.

Results: From a total of 126 citations, 15 articles were selected for inclusion in the final review. Currently, nine countries globally are actively developing and implementing nurse-led DR screening models, with Australia leading in the number of such programs. Our search of literatures demonstrated the roles and contributions of nurse-led DR screening encompass research and leadership, consultancy, health management, technical expertise, and data collection. The supports required and challenges faced include transforming traditional screening models, providing adequate training, securing financial resources, and enhancing career motivation.

Conclusion: The nurse-led model is a promising approach in DR screening that integrates eye examinations, diabetes education, data collection and fundus imaging within a single encounter, thereby improving efficiency and lowering costs. It may thus be considered a scalable approach for the future expansion of screening programs.

Purpose: To describe the intraoperative Flutter Sign as a real-time indicator of anterior hyaloid face (AHF) integrity following posterior capsule tear (PCT) during phacoemulsification.

Design: Single-centre observational study combining retrospective review of twelve intraoperative PCT cases with prospective evaluation of eight additional cases. Retrospective observations guided structured assessment in the prospective arm, focusing on PCT edge behaviour and AHF integrity.

Methods: Surgical videos of twelve eyes with intraoperative PCT were analysed for tear edge morphology and motility. Based on these findings, eight prospectively observed PCT cases were examined intraoperatively for edge behaviour and AHF status. Additional parameters included need for vitreous surgery, type of intraocular lens (IOL) implanted, and intraoperative and postoperative complications associated with PCT.

Results: Eleven eyes demonstrated sharp, fluttering PCT edges with intact AHF, no vitreous prolapse, and no need for anterior vitrectomy. Of these, five received in-the-bag IOLs, while six underwent sulcus fixation. All achieved a best corrected visual acuity (BCVA) of 20/20. Nine eyes exhibited scalloped, non-fluttering edges, consistent with AHF rupture and vitreous prolapse. All required anterior vitrectomy and sulcus-fixated IOLs. Three patients in this group experienced posterior migration of lens material: two had small cortical or nuclear fragments that were clinically insignificant and required no intervention, while one patient had a large nuclear fragment that necessitated a secondary procedure for removal. BCVA was reduced in two eyes to 20/30. Two patients experienced transient elevation of intraocular pressure. No cases of retinal detachment or endophthalmitis were observed.

Conclusion: The Flutter Sign is a simple, dye-free, real-time indicator of AHF integrity after PCT, with fluttering edges signifying intact AHF and scalloped static edges indicating vitreous prolapse.

Purpose: We evaluated the ability of ChatGPT, an Artificial Intelligence (AI) Chatbot, to respond to patient eye health queries.

Methods: A retrospective, cross-sectional analysis of eye health questions and physician responses posted on the American Academy of Ophthalmology (AAO) "Ask an Ophthalmologist" forum was performed on a random sample from January 2016 to December 2022. We compared board-certified ophthalmologists' responses to ChatGPT (version GPT-4o, OpenAI) responses in September 2024. Primary outcomes included ophthalmologist-rated accuracy of ChatGPT and AAO responses using a 7-point Likert scale, as well as ophthalmologists' preferences between the two responses. Secondary outcomes assessed differences in readability, empathy, and response length between ChatGPT and ophthalmologists.

Results: A random sample 250 questions and responses from 41 board-certified ophthalmologists were evaluated. ChatGPT and AAO responses had similar mean accuracy ratings (5.8 [SD=1.1] vs 5.5 [SD=1.1], p=0.07). Evaluators preferred ChatGPT over physician responses in half (49.5%) the cases. Ophthalmologist responses were easier to understand, with a lower mean Flesch-Kincaid Grade Level (Grade 11.0 [SD=2.7] vs Grade 12.7 [SD=1.9], p<0.001). Ophthalmologist responses were also significantly shorter than ChatGPT responses (80.6 [SD=56.4] words vs (337.8 [SD=141.6] words, p<0.001). Empathy ratings did not differ significantly between ChatGPT and ophthalmologists (4.4 [SD=0.6] vs 4.4 [SD=0.6], p=0.5).

Conclusion: Our findings suggest that Chatbot responses were as frequently preferred as physician responses, rated with higher accuracy, and demonstrated comparable empathy in addressing online patient eye health queries. AI chatbots may assist in drafting initial responses to patient concerns, potentially improving efficiency and reducing physician workload.

Purpose: To evaluate ocular health status, vision-related quality of life, and access to eye care services among a multi-ethnic refugee population in the Greater Toronto Area (GTA).

Methods: Participants completed a structured survey capturing demographic, medical, and vision-related data. Descriptive statistics were employed to summarize and interpret the responses. Canadian population data were sourced from Statistics Canada and National Vision Health Reports. Participants were recruited during ophthalmic screening outreach visits at four refugee housing sites in the GTA, and were eligible if they were adults or mature minors residing in refugee homes after arriving in Canada as refugees or asylum seekers between October 2022 and October 2024. Proportions were converted to estimated counts for comparison, and harmonized categorical variables were analyzed using Pearson's Chi-Square or Fisher's Exact Test. Bivariate and multivariate logistic regression models were then used to assess associations between demographic, clinical, and psychosocial factors and two outcomes: difficulty coping with life due to vision and history of barriers to eye care.

Results: Among 94 refugee participants (mean age 46.5 years; 41% female), rates of recent eye exams (19.1%) and prescription glasses use (51.1%) were significantly lower than in the Canadian population (74.5% and 81.0%, respectively; p<0.0001). Over half (55.3%) were dissatisfied with their vision, and financial barriers (50%) were the most reported obstacle to care. Prior abuse was associated with greater odds of encountering barriers (OR=7.65, p=0.005), while dissatisfaction with vision (OR=0.11, p=0.025) and interference with daily activities (OR=233.0, p<0.0001) strongly predicted difficulty coping.

Conclusion: Refugees face significant vision-related health disparities. Interventions should address access, government benefits, education, and psychosocial supports.

Purpose: To assess the visual and anatomical outcomes of retinopathy of prematurity (ROP) after treatment with laser therapy versus intravitreal anti-vascular endothelial growth factor (anti-VEGF) in real-world practice.

Methods: This retrospective cohort study included preterm infants with treatment-requiring ROP that underwent either laser indirect ophthalmoscopy (LIO) or intravitreal anti-VEGF therapy at Ramathibodi Hospital from January 2012 to October 2023.

Results: This study included 52 patients (104 eyes). The anti-VEGF (18 patients: 36 eyes) and LIO (34 patients: 68 eyes) groups had comparable baseline characteristics, including mean gestational age (25.80±2.81 vs 25.89±3.84 weeks; p=0.906), birth weight (693.0±34.30 vs 784.5±45.57 g; p=0.170), and mean follow-up duration (4.12±0.59 vs 4.91±0.57 years; p=0.361). Treatment occurred significantly earlier in the anti-VEGF group (postmenstrual age 33.94±0.53 vs 36.30±0.55 weeks; p=0.006). The anti-VEGF group required more follow-up visits from the initial exam until the complete regression of ROP (20.03±10.00 vs 11.80±6.03; p<0.001). The mean final visual acuity (VA) was similar between the anti-VEGF and LIO groups (logMAR 0.490 vs 0.480; p=0.852), although Zone I eyes treated with anti-VEGF tended to have better VA. Among Zone I eyes, those treated with anti-VEGF had significantly less myopia (mean spherical equivalent: -0.60 vs -12.30 D; p=0.007). Only the anti-VEGF group underwent secondary treatment, mainly for persistent avascular retina (44.4% vs 0%; p<0.001), and had treatment failure (16.7% vs 0%; p=0.002).

Conclusion: Both anti-VEGF and laser therapy demonstrated nonsignificant difference in functional and anatomical outcomes in treatment-requiring ROP. Notably, Zone I eyes treated with anti-VEGF exhibited significantly less myopia versus those treated with LIO. However, the anti-VEGF group required significantly more hospital visits and secondary treatments.